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ROW2011-00091 I RIGH CITY OF TIGARD T OF WAY PERMIT ` !. COMMUNITY DEVELOPMENT Permit #: ROW2011 -00091 . Date Issued: 11/10/2011 Ti'G 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: SEG1868 Jurisdiction: TIGARD Site address: Subdivision: Lot: Project: Comcast Project Description: Underground road crossing SW 72 Ave, approx. 60' long 2" poly pipe running east -west crossing SW 72nd Ave at 14255 SW 72nd Ave. , Tigard, OR. Underground 2" poly pipe w /directional bore. Owner: FEES Description Date Amount ROW Permit Fee 11/10/2011 $300.00 PHONE: Contractor: PHONE: FAX: Applicant: COMCAST 14200 SW BRIGADOON CT. BEAVERTON, OR 97005 PHONE: 503 - 572 -1556 Total $300.00 Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact information of responsible parties before beginning work. Permittee /Applicant Signature: Issued By: /S Special Conditions (See Attached) Note: THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for ROW2011 -00091 Type: Condition Name: Status: Severity: ROW 01- CUSTOM CONDITION Applied Notice Repair of utility location corings with slurry and Perma Patch is acceptable, Pavement may not be cut in SW 72nd until 2014 under the Right -of -Way Preservation Program. Traffic may not be delayed from Thanksgiving to New Years under Resolution No 01 -66 (map attached). ROW 02- PERMIT & PLAN REQ ON SITE Applied Notice A copy of the permit and all attachments, and a copy of the approved construction plan and all amendments shall be available at the work area. All work shall conform to the permit terms, conditions and provisions and to the City approved permit plans, and approved plan amendments and to the City's Standards and Specifications and to these General Conditions. Changes to any of the aforesaid must be approved by the City, in advance of work performance. ROW 03 -TRAF CTRL - SPECIF (CITY) Applied Notice The City's standard specification for traffic control is "Manual on Uniform Traffic Control Devices for Streets and Highways ", U.S. Dept. of Transportation, F.H.A., 1988 Ed. ROW 04 -TRAF CTRL -CONTR RESPON FOR Applied Notice Traffic control shall be provided for by the contractor in accordance with the City's standard specification and, also, in accordance with a City (job specific) approved traffic control plan. A copy of the approved traffic control plan shall be available at the work area. ROW 05 -TRAF CTRL -ROAD CLOSURE Applied Notice Public roadway shall not be closed to traffic, at any time, without having first obtained written approval from the City Engineer. The permit holder is responsible for provision of timely notification of traffic flow disruptions to area wide • Emergency Services (Tigard Police Dept., Tualatin Fire & Rescue) and to Tri -Met and Tigard School District. ROW 06 -TRAF CTRL - ADVANCE WARNING Applied Notice Advance warning of imminent traffic disruption shall be provided to the general motoring public by placement of an advance notification sign at each end of the construction area 72 hours (min.) before initiation of construction work. ROW 07 -TRAF CTRL -PRIV PROP ACCESS Applied Notice Access to existing properties shall be maintained at all times, including normal delivery service and mail service and if not, shall be cause for work stoppage until effective access is established. ROW 08 -TRAF CTRL - DEVICES IN PLACE Applied Notice Traffic control devices, flagpersons, etc., shall be in place prior to initiation of construction work and shall be effectively maintained. ROW 09 -TRAF /NOISE CTRL -WORK HRS Applied Notice No work will be permitted during the hours of darkness, nor between 9:00 p.m. to 7:00 a.m. Monday through Friday, nor between 9:00 p.m. to 8:00 a.m. Saturday, nor between 9:00 p.m. to 9:00 a.m. Sunday. ROW 10 -TRAF CTRL -MIN LANE WIDTH Applied Notice Minimum travel lane width shall be eleven (11) feet; pedestrian travel shall also be provided for. ROW 11 -TRAF CTRL -CITY CAN MODIFY Applied Notice The City reserves the right to add to or modify traffic control requirements as may be necessary to effectively control traffic and to assure public safety. ROW 12 -INSP 24 HR NOTICE REQUIRED Applied Notice The permit holder or his contractor shall notify the City's inspector Zen Dutson, at 503 - 718 -2472 or email at zen @tigrd- or.gov, twenty -four (24) hours prior to commencing work, twenty -four (24) hours prior to any staged inspection, and after completing work covered by the permit. ROW 13- HAZARDS -CERT OF INS Applied Notice Maintenance of the work area and approach roads is the responsibility of the permit holder. The work area and approach roads shall be maintained in a clean condition, free from obstructions and hazards. A copy of the permit holders Certificate of Insurance shall be available at the work area. ROW 14- DEBRIS - MATERIALS Applied Notice The spreading of mud or debris or storage of materials or equipment of any kind upon any public roadway is strictly prohibited and violation shall be cause for immediate cancellation of the permit. The City may at any time order immediate cleanup and stoppage of work to accomplish cleanup. ROW 15- EROSION CTRL REQ Applied Notice Effective erosion control is required. Erosion control devices must be installed and maintained meeting D.E.Q. requirements. The City may at any time order corrective action and stoppage of work to accomplish effective erosion control. ROW 16- REPAIRS -LIKE MATERIALS REQ Applied Notice Property disturbed by construction activity shall be seeded with a standard grass mix; shrubs, flowers, barkdust, existing signs, pavement markings, mailboxes, etc., shall be reestablished, reinstalled or replaced, with like kind and material. ROW 17- DRAINAGE CONTROL REQ Applied Notice Effective drainage control is required. Drainage shall be controlled within the work site and shall be so routed that adjacent private property, public property and the receiving system is not adversely impacted. The City may, at any time, order corrective action and stoppage of work to accomplish effective drainage control. ROW 18- UTILITIES PRELOCATION REQ Applied Notice Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. Copies of the rules may be obtained from the Center by calling (503) 232 -1987. If you have questions about the rules, contact the Center. NOTE: Damage to utilities shall be corrected at the permit holders expense. ROW 19- UTILITY LOCATIONAL CONFLICT Applied Notice Contractor must verify all existing utilities for both vertical elevation and horizontal location prior to start of work (pothole before digging if necessary). Should conflicts arise and redesign or relocation of facilities be necessary, it shall be done at the permit holders expense. Changes must be approved by the City in advance of work performance. Contractor shall coordinate the work with affected utility agencies. ROW 20- TRENCH - PATCH /SAFETY /LBILITY Applied Notice A temporary hard - surface patch (Cold mix A.C. or Hot mix A.C. base paving) shall be placed on trenches within roadways at the end of each day's work. No trench, on site or off site, shall be left at any time in an unsafe condition. The permit holder is responsible for and is liable for hazards or damage resulting from the work. ROW 21- REPAIRS REQ - INSPTR OPINION Applied Notice Work provided for under the permit shall include repair of existing facilities (roads, ditches, etc.) as may be necessary, in the City Inspectors opinion, to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit. Corrective work shall be done at the permit holders expense. ROW 22-AS-BUILT/ENGR CERTIF REQ Applied Notice At the end of each year, or an a mutually agreeable yearly date, any entity making changes to its facilities in the public right -of -way shall submit complete "as- built" drawings showing all new public improvements, including any revision made to the previously approved construction plans and, also, any improvement which may impact an existing public system or facility, shall be provided to the City by a registered civil engineer along with an engineers certification of installation compliance (form attached). ROW 23 -DAILY INSP REPORTS REQ Applied Notice The permit holders Engineer /Inspector shall submit daily inspection reports, on a weekly basis, to the City's Inspector. (see Developer- Engineer Agreement note #5). ROW 24- TESTS /REPTS TO VALIDT CLMS Applied Notice The City's Inspector may, at their discretion, require provision of tests and or reports from the permit holder, permit holder's engineer or contractor to validate claims of material or construction adequacy /compliance. Such tests /reports shall be provided at the permit holder's expense. ROW 25- RELEASE - WAIVER REQ Applied Notice The permit holder shall provide a copy of a properly executed Release & Waiver document to the City for each ownership disturbed by construction activity, as evidence of disturbance resolution and owner satisfaction. ROW 26- MONUMENT PROTECTION REQ Applied Notice Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holders expense. ROW 27 -PROB SOLVING - RESPON PARTY Applied Notice The permit holder shall provide to the City Inspector, in writing, the names and 24 -hour emergency telephone number of two (2) persons who have authority to resolve problems, take corrective action and, in general, will be responsible in case of an emergency. The permit holder shall notify the City Inspector, in writing, of any /all assignment changes. ROW 28- CONSTR SAFETY - RESPON PARTY Applied Notice The permit holder shall cause his contractor to provide to the City Inspector, in writing, the name and 24 hr emergency telephone number of a designated "Competent Person" responsible for construction safety as per OR -OSHA, Chap. 437, Div. 3 Construction, Subdivision P - Excavations. The contractor shall notify the City Inspector of any /all assignment changes. ROW 29- ESMT /RT OF ENTRY - RESPON Applied Notice It is the sole responsibility of the permit holder to provide for proper right -of -entry and /or easements prior to starting work. Proof of right -of -entry, or properly executed easements, shall be provided to the City. The City shall in no way be construed to be liable for the permit holder's failure to obtain or provide for proof of right -of -entry or easements. RE C8VE NOV 0 8 2011 City ofraar��i�� l C /11/40 -m V ® t ®f�1P, ,a!° � �1 z The -application vl Work In Right-Of-Way L.,4:fq, ROW Permit 094,-- FOR STAFF USE ONLY General Information: e� Right -of- Way Property Address /Location(s) _ Case No.: L CO 0 20 I I 000 9/ 9 a s 5 S w ! �f Z � / I L;/1 °.) Receipt No.: / Q �/ $ 7 5 e� / e :r Date: I / / .� *Applicant's Name: OA? C4 S 7 j a Application Accepted By: x• 5P Address: ! '2 o S i- -' ,jie,,,2 27 a/ cr. Revised 7/1/10. i1 •/ I 3Gc.3 a City/State: 2 et ire TSSJ oR Zip :970 0..5 Primary Contact: ,3r'O "1.5 0 v 4-d /J S _ REQUIRED SUBMITTAL Phone: So 3 57 2- /SS`( Fax: INFORMATION Contractor's Name: ,c 8 . eO m CCB #_ /7 Gs Zeo g Expiration: Submit a scaled sketch of the proposed Address:] 730 La.) c, d /� �{ work to be done City /State: U[i/e / / ,; V Zip: y 70 4 Phone: J b 3 S 77 0 33 / Fax: co3 5 e Professional Engineered Plans are required for: Plans By: o Street Widening Address: o Subdivision Infrastructure o Main utility line extension: City /State: Zip: Phone: Fax: I:curpL -i \masters \land use applications \ row app.docx Underground road crossing SW 72 Ave , aprox 60' long 2" poly pipe running east -west crossing SW 72 " Ave at aprox. 14255 SW 72 " Ave, Tigard OR. Underground 2" poly pipe w/ directional bore . Estimated value of work (within the public right -of -way): $ 7 00 0 0 Is work related to.a LAND -USE DECISION? YES NO If so, please specify (MLP, SDR, SUB, etc.) case #: Is the work related to a BUILDING PERMIT? YES I NO If so please specify (BUILDING PERMIT) case #: *NOTFi: Person specified as "Applicant" shall be designated "Permittee" and shall provide financial assurance for the work. City of Tigard ( 13125 SW Hall Blvd., Tigard, OR 97223 ( 503 -718 -2464 ( www.tigard-or.gov I Page 1 of 1 i rro' ce 4 -I el, CZ) Drop Bury Request. Form Complete Alf Fields Tech #: 30801 Drop Bury Work Order #) Service Affected: Install 1 Service Date: Reason for Drop Bury Request Customer Name: Fought & Co 1) Drop has ingress? Ch: _ Reading: Address: 14255 SW 72nd Ave 2) Drop is damaged City: Tigard 3) Drop is surfaced and susceptible to damage Zip Code: 97224 4) Drop exceeds loss parameters State: OR 5) Drop size is not adequate for distance Phone #: 503- 639 -3141 6) Customer request to be contacted Altn phone #: 7) Reason for contact- Note below in note section Commercial Customer? Yes r 8) Needs Bore? < enter bore footage Node #: TG1 1$ ! < Enter bore type Thomas Guide: Page/Grid <9) Total Length of drop from ped /pole to house < 10)Total bore footage on map. Notes: Bring drop to the ladder rack by the NE part of back building. Nearest Cross Street: Drop Status Drop repaired - Needs replaced - NO TEMP New connect - Temp on Ground Signal levels Ch. 3 Ch. 71 Ch. 92 Ch. 135 Reconnect - Temp on Ground Tap Trouble Call - Temp on Ground House New connect/ Pro Bury - No Temp on Ground , ' �� a c ;� .,.� [- ec'.; DRAW MAP BELOW, Addres On Etcher Stde of D op,Route and Nears ;3 Please drawn `" large etiough toe,1 elude ail�d`e=tatls an, d 'Obstacles of the drop boy - t .` _ -- -_e. -`t t L : € a.` ' . m i \ k :::. l AO MC ; s ''mss": ( 4. `, Contractor : First Contact RAB COMMUNICATIONS 19730 SW Cipole RD. #3 Tualatin Oregon 97062 CCB 176268 Contacts , Dave Freeman 503 577 0331 dfreeman@rabcom.com , David Runyon 503 569 9865 drunyongrabcom.com APPLICANT : COMCAST CABLE 14200 BRIGADOON CT. BEAVERTON OR. 97005 Bronson Adams , c- 503 572 1556 , email Bronson Adams@cable.comcast.com JOB LOCATION : UG underground directional bore road crossing at 14255 SW 72 Ave to install Comcast services . Underground road crossing SW 72 Ave , aprox 60' long 2" poly pipe running east -west crossing SW 72 Ave at aprox. 14255 SW 72 Ave, Tigard OR. Underground 2" poly pipe w/ directional bore . City of Tigard Resolution No. 01-66 Construction Activity within the public right -of -way on specific streets in and around the Washington Square Mall, downtown Tigard, a. Q-, c o and within the Tigard Triangle shall be limited , o\'' between Thanksgiving and New Year, ? o�� r Y �c' R's ► as shown on the map. I` - o' ali'� 'm i ', ' }Y RD The City Engineer would have the authority to , ij 4 °�i waive this provision for emergency situations or , l, ' - - when the work does not impact traffic flow. , ' \ i o E , . -11 Hwy 99w -:i - — __ 'fir _ Scholls Ferry Rd f ti "' 1 E Cascade Ave ➢ ` _ r 1 J Mie �i Greenburg Rd Hall Blvd :� � '` _ _ `y�� ®� �F �w Locust St R D ' ; ` , ' '�'!!��; j ; DAKO A S'_, , 2 I II Tigard St C � �! ( f a �i ; P T �. Commercial St `= _ � - _ J . P f Burnham St i ,- -- 1 - ' ' _ 4 Ash Ave w_ X11 �, " > __. r Main St � •r � 4 � y Scoffins St my, f � �' __ - � fi� r{ ��NUT ! � . \ - - - '--W I -- Dartmouth St, 72nd Ave a _- ! - '� . L__ 4 ; -- T , P ` S 68th Ave 4 I ma, , = ,..„, w - fp, ,......, , , ,...„, , 6 / - ti , Will 4 01 L p°' �y t MO _ � lia BO A f a rt . i f it — 1 I-1 ' 1 r . _ , °, - Z . tp 14160 en 'pi + 14160 WPM 12A08904 El + 12A012C FH12A08801 ' Q11C WFJD12A08903WND92A08901 ti 512 - -r . WND A0 W A D 12A008 0 1 D i a : 10 ' - } ' WV12A08803 W4/32a08901 1 ?i WND12A08902 4. ' p i f. c �f 4 0 0 r . • 1 N 14280 F j 9 j 1 SS 12A010 i' 12A01 12A016 12A014C HV14 0001F H12A 08701 jt Feet 0 125 , a CITY OF TIGARD RECEIPT '; 13125 SW Hall Blvd., Tigard OR 97223 i ; r , 503.639.4171 TI GA:RD Receipt Number: 184557 - 11/10/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ROW2011 -00091 ROW Permit Fee 100 - 0000 -43114 $300.00 Total: $300.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 09077Z KPEERMAN 11/10/2011 $300.00 Payor: PAULA FREIBERGER Total Payments: $300.00 Balance Due: $0.00 Page 1 of 1